Investigators follow a trail of death

Joe McDermottOf The Morning Call

The stunning revelations of a Bethlehem critical care nurse who admitted killing up to 40 patients have investigators, hospitals and medical centers across the Lehigh Valley scrambling to identify possible victims.

They hope that Charles Cullen will provide the names to resolve a number of suspicious deaths that coincided with his 16-year career, but some are concerned that even he might not remember them all.

Among the 30 to 40 alleged mercy killings Cullen reportedly confessed to Somerset County investigators over the weekend may be several suspicious deaths at St. Luke's Hospital in Fountain Hill that were investigated in 2002. Those cases are again under review by Lehigh County authorities.

"Obviously, we are trying to determine one, whether that is factually true, and two, who these victims were. Hopefully he will be able to provide some names. I anticipate there will be some patients he will not be able to identify," said Lehigh County District Attorney James B. Martin.

He said Pennsylvania State Police probably will try to talk to Cullen.

"We've been assured we will have full cooperation from New Jersey, and I believe that we will," Martin said.

He said his office got three or four calls Tuesday from people who questioned the circumstances under which their loved ones died at area hospitals. "For one reason or another, some of those people felt that their deaths were suspicious," Martin said. "We have been acquiring that information and passing it on to state police."

Martin said he had asked Dr. Isidore Mihalakis, the Warren County medical examiner, to review medical records in the original probe. "We were unable to form a conclusion that there was probable cause" for further action against Cullen with respect to any of the deaths, he said.

Mihalakis said Tuesday that Lehigh County prosecutors had asked him to review hospital records, but he wouldn't elaborate. "It was just a general investigation to see if there was anything potentially provable," he said.

The investigation was hindered by the fact there were no toxicology reports on the patients to indicate what drugs were in their bodies. There may have been an autopsy on one of the patients, Martin said.

Cullen, arrested Friday on charges of killing a priest and administering a lethal dose of heart medication to a cancer patient at New Jersey's Somerset Medical Center in June, remains in Somerset County jail on $1 million cash bail and has told authorities he killed 12 to 15 people during his 13 months as an intensive care nurse at the Somerville hospital.

Warren County prosecutors have reopened an investigation in the 1993 death of Helen C. Dean, who had been a patient at Warren Hospital in Phillipsburg while Cullen worked there. Northampton County Coroner Zachary Lysek said he is reconsidering the death of at least one patient at Easton Hospital during Cullen's tenure there and examining others that occurred during the same period.

Jeff Beach, spokesman for the New Jersey public defender's office, said Cullen's application for a defender was approved and he is working with Deputy Public Defender Johnnie Mask in Somerville while awaiting the appointment of permanent counsel.

Somerset County Prosecutor Wayne Forrest would not say if Cullen has identified any victims, but has said he will provide information to other law enforcement agencies.

"I can't say anything about what he said other than what was said in our public documents," Forrest said.

However, he did confirm that his office is awaiting autopsy results from the county medical examiner on a possible third victim.

"We've been working since October on these two cases," he said, referring to the death of the Rev. Florian Gall and the alleged attempted murder of Jin Kyung Han, a Basking Ridge, N.J., cancer patient.

Cullen is accused of administering lethal doses of the prescription drug digoxin to both victims.

Gall, a Roman Catholic priest from Whitehouse Station, died June 28.

Han, 40, also suffered from heart problems but survived after she received an antidote to the digoxin overdose. She was discharged but later readmitted to Somerset Medical Center, where she died Sept 5.

Han was born in Korea, lived in New Jersey as a homemaker, and left behind a husband and two children.

The unusually high digoxin levels in the blood of both victims triggered an internal investigation at Somerset, said Dr. William K. Cors, senior vice president and chief medical officer at the growing facility. In addition, at least four other patients were found to have unusually high digoxin levels or unusually low insulin counts.

Somerset called in the New Jersey Department of Health and the state Poison Control Center and hired a private investigator to eliminate any possibility of accidental death.

A review of patient and employee records showed at least one consistent fact. "One nurse's name kept coming up," Cors said, confirming it was Cullen's. "We are great at taking care of sick people; we are not great investigators.

"As we were eliminating hypotheses, we were coming to the conclusion this was an intentional act, so we contacted the Somerset County prosecutor's office," Cors said.

He said he was never aware that Cullen had been named as a probable culprit in the over-medication of a patient at Liberty Nursing Home in Allentown in 1998.

Bethlehem attorney Donald Russo represented former Liberty nurse Kimberly Pepe, who was fired for alleged misconduct related to a patient's hospitalization with high insulin blood levels. The patient was not identified by the nursing home or in the suit but Russo had filed a subpoena in the case seeking the medical and death records of a patient named Francis Henry.

The suit contended that Liberty intentionally overlooked any evidence pointing to the fact that Cullen may have administered insulin to the patient.

"On the other hand, while the plaintiff's record was clear, her co-worker Cullen's record was under suspicion for several serious matters," Russo stated in the suit, which was settled in October 2001. Liberty denied knowledge of those matters in its reply to the suit.

"As a citizen, I am concerned that there was a public document filed in 1999 that there was clearly indications that there were suspicions about Charles Cullen," Russo said Tuesday. "My concern is how many people have died since 1999 who could have been saved if somebody had taken action against this man?"

Liberty officials said earlier this week that Cullen was later fired for failure to follow procedures. They said they conducted an internal investigation and alerted the state Department of Health about the incident, but they believe no harm came to patients during his employment.

Instead of waiting for family members to call Liberty, staffers spent Tuesday calling relatives of all 144 residents, said spokeswoman Christine Emrick. She said they reached at least 48 families.

The home also was pulling files of residents who could have been cared for by Cullen between February and October 1998, but Julie Beckert, director of corporate communications in Toledo, could not say how many files or deaths were involved.

"I don't have that information," she said. "These are five-year- old records not easily pulled out."

St. Luke's Hospital geared up for calls from relatives wondering if their loved ones had connections to the Cullen case, but officials said they only received one.

LVH would not say if it got calls, and while officials said they are looking at suspicious deaths, they provided no information on how many deaths or how long the review would take.

Sacred Heart in Allentown, which employed Cullen for 18 days in July 2002, got no calls, said spokesman Chris Sodl. Sodl said one death on Cullen's unit was not related to his employment.